Under the prevailing scenario there is a high possibility of, Chemical, Biological, Radiological & Nuclear (CBRN) warfare agents falling in the hands of terrorist groups, imposing great challenge of CBRN terrorism. Chemical and Nuclear agents can be used as “Dirty Bomb” where these agents are packaged with explosive material. On explosion “Dirty Bomb” will cause contamination of environment causing hazardous effects on health. Nuclear agent can be used as “Suitcase Nuke” having a weight of 10 kg only while it will have a yield of 10-20 KT, with radiation effect upto 4-5 kms radius.Usually Cesium-137 or Cobalt-60 are the nuclear material used in the dirty bomb which has got long half life causing the delayed radiation effect in the form of cancer, cataract, genetic damage, premature aging and infertility. The virulence of biological agent can not be undermined as they are cheap, easy to produce and only small amount is required to play havoc. Bacteria like anthrax, virus like small pox, toxins like botulisms toxin are most commonly used as biological agents.

In addition to CBRN terrorism, nuclear or chemical disaster can also occur due to accident either in nuclear reactors, chemical plants or during transportation of nuclear or chemical material. Accidental release of biological agents from a Biosafety lab will cause biological disaster. CBRN disaster will cause tremendous devastation to human and other living beings, flora, fauna and environment including air, water and soil.

Radiological emergency may arise due to unsafe disposal of nuclear material as happened in April 2010 in the Mayapuri incident wherein eight cases were hospitalized due to radiation injuries caused by Cobalt 60 orphan source. Chlorine gas leaked out from cylinders lying at Mumbai port in July 2010. Consequent to the tsunami of 11th March 2011 off the Japanese coast, there was a nuclear accident in the Fukushima Nuclear Power Plant of Japan which caused widespread radiation contamination in the surrounding area.In 2010, toxic chemicals were dumped in Rayoram river in Kerala affecting few people. It is heartening to note that in all these incidents, the CBRN trained National Disaster Response Force (NDRF) team, rose triumphantly to the occasion to contain these hazardous threats and their work was lauded even by the Japanese Prime Minister. There are possibilities of accident in Chemical industry as the memories of Bhopal Gas tragedy are still fresh in our minds.

Management of disaster in Chemical ,Biological, Radiological & Nuclear scenario poses the great challenge because of the contamination. In CBRN environment search, rescue and quick reaction medical team has to put on protective clothing, respiratory masks, boots and gloves which reduces the working efficiency. Personal protection, detection, decontamination, decorporation, vaccination and antidote administrations are extra special requirement for management of CBRN casualties along with the usual care of heat, blast and infection effects. Nuclear agents mainly cause acute haemopoetic, gastrointestinal, cutaneous and CNS syndrome while chemical agents adversely affect eyes, skin, respiratory and nervous system, of course biological agents can severely infect any part of body causing casualties in pandemic proportion.

For managing CBRN disaster, prevention, mitigation, preparedness, capacity building training and communication is to be considered as integral part of National framework for disaster management planning. The emergency response plans have to be deviced at all levels i.e. community, district, state and nation as a whole. District Disaster Management authority is the nodal agency for planning, preparedness and implementation of plants in case of any eventuality. Rescue and quick reaction medical team, doctors, paramedical and nursing staff are to be trained. Standard Operating Procedures (SOPs) need to be written. Mock drills and exercises to be carried out regularly.

CBRN disaster management can only be possible by full involvement and total commitment of various organizations like fire services, police, communication, health services including ambulance service, hospitals. Multi-dimensional impact of CBRN disaster requires multi sectoral and multi-disciplinary approach for development of trained manpower, equipment and other facilities needed for the handling of CBRN disaster. Provision of clean water supply, safe food, hygiene and sanitation, environmental health and control of vectors is to be planned to prevent any epidemic in the aftermath of CBRN disasters. Health care facilities are an essential component of emergency medical response system, but at the present, are poorly prepared for an incident.

The greatest challenge may be the sudden presentation of large number of contaminated individuals. The key elements of the health care facilities response plan include prompt recognition of the incident, staff and facility protection, patient decontamination and triage, medical therapy and co-ordination with external emergency response and public health agencies. Special facilities to treat CBRN casualties are to be created in the hospitals including CBRN filter fitted ward and bio-waste disposal system. Earmarked hospitals are also to be geared up for restitution of immune system, bone marrow/stem cell transfusion, medical stores containing antidotes, vaccines, decorporation agents and antibiotics. Management of post-traumatic stress disorders is also to be catered. Planning is to be done to deal with long term effects of radiation like cancer, cataract, genetic damage and premature ageing. Documentations, research and analysis is to be carried out in post-disaster scenario for future lessons.

NDMA with the active participation of all subject stakeholders across the country formulated National Guidelines on Biological Disasters including Bioterrorism, Nuclear & Radiological Emergencies, Chemical Industrial Disaster and Chemical Terrorism Disaster Management. Based on these National Guidelines, the Action Plans are being prepared by all stakeholders, whereby the morbidity and mortality consequent to CBRN emergencies can be curtailed by comprehensive planning, preparedness and capacity development for prompt and effective emergency response. During Commonwealth Games 2010 NDMA planned CBRN security and procured equipment. 1500 NDRF personnel were deployed at various venues.

NDMA also took upon the onerous task of training the medical fraternity of Delhi government. About 400 doctors and paramedical staff were trained in the medical management of CBRN casualties. Subsequently, a similar course was conducted for NDRF doctors and Pharmacists from 30th July to 1st August 2012. In year 2010 the NDMA was requested to impart CBRN training to security staff of Parliament House Complex and accordingly, 12 courses were conducted. Police is responsible to maintain safety and security of CBRN agents especially during their storage and transportation. Therefore, training of police personnel and equipping them with CBRN equipment for protection, detection and decontamination is very essential. With this backdrop, the NDMA had conducted Training Programmes on CBRN Security, Preparedness & Emergency Response for Chandigarh Police and Delhi Police. Such capacity building has also been undertaken at the State Administrative Institutes of Haryana and Himachal Pradesh.

CBRN Training Programme includes sessions of theoretical lectures and practical demonstrations. Training faculty is the CBRN experts from 8th Battalion NDRF Ghaziabad, NDMA, Army Headquarters, Integrated Defence Staff, Air Force Institute of NBC Protection, Defence Research & Development Establishment Gwalior, Defence Laboratory Jodhpur, Institute of Nuclear Medicine and Allied Sciences Delhi, Bhabha Atomic Research Centre Mumbai, Inter University Accelerator Centre New Delhi, JPN Apex Trauma Centre of All India Institute of Medical Sciences New Delhi and Delhi Fire Service. Lectures are delivered in language convenient to trainees and followed by demonstration to practice the theoretical knowledge on ground. The mock drill is the part of training so that participants can have full picture for response to CBRN scenarios. CBRN disaster preparedness will ensure to build safe and a disaster resilient India by developing a holistic, pro-active, multi-disciplinary and technology-driven strategy by all stakeholders including community.